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2
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Insured health care costs for which one is responsible, because of the application of deductibles, coinsurance and co-payments
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3
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refers to money that an individual is required to pay for services, after a deductible has been paid. Coinsurance is often specified by a percentage.
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4
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a limit on the amount of benefits paid out for a particular covered expense, as disclosed on the Certificate of Insurance.
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5
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refers to the amount payable by the insurance company to a claimant, assignee, or beneficiary when the insured suffers a loss.
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8
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Medical equipment used in the course of treatment or home care, including such items as crutches, knee braces, wheelchairs, hospital beds, prostheses, etc..
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12
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The process through which a patient under a managed care health insurance plan is authorized by his or her primary care physician to a see a specialist for the diagnosis or treatment of a specific condition.
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13
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A bill for medical services rendered, typically submitted to the insurance company by a healthcare provider
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20
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Deductible the amount an individual must pay for health care expenses before insurance (or a self-insured company) covers the costs
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21
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An event that triggers coverage under the policy.
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23
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a provision within a health insurance policy that eliminates coverage for certain acts, property, types of damage or locations.
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25
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Systems and techniques used to help direct, manage the utilization, cost and quality of healthcare services to enhance the quality and cost-effectiveness of care
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27
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This is a requirement that an insured person calls their health insurance company and advises them a doctor has stated certain medical treatment is required. This is done before receiving treatment from the doctor or hospital
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28
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This phrase usually refers to physicians, hospitals or other health care providers who are considered nonparticipants in an insurance plan (usually an HMO or PPO)
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29
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The amount you could be responsible for (in addition to any co-payments, deductibles or coinsurance) if you use an out-of-network provider and the fee for a particular service exceeds the allowable charge for that service
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30
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a term used by insurance companies, case managers and/or employers to describe the amount of time an individual stays in a hospital or in-patient facility
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32
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The process used by health plans to determine the amount of payment for a claim.
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33
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Expenses defined by the health insurance plan as eligible for coverage.
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34
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the date a member’s insurance coverage commences
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